The Power of Data to Reach Vulnerable Communities in Ghana
In May 2022, Sabin’s Boost Community and the World Health Organization (WHO) launched the first cohort of the "COVID-19 Recovery for Routine Immunization Programs Fellowship". The aim of this program was to strengthen the capacity of national and sub-national immunization professionals to plan and implement immunization programming during the COVID-19 recovery period, with the ultimate goal of reversing the declining rates of immunization coverage. After an intensive live engagement series, Fellows were tasked with drafting their own strategic proposal for implementation or case study for publication. This series of Bright Spots share Fellows' key learnings and takeaways from the program.
“As a young medical officer, I started seeing a number of children with vaccine preventable diseases like measles appearing in the hospital,” Dr. Hilarius Asiwome Kosi Abiwu said. “I found out a number of these children were coming from the areas that didn’t have any healthcare facilities and barely [had] access to routine immunization services.”
Hilarius has worked in the immunization space since 2007 and currently serves as Deputy Director of Public Health in the Tamale Metropolis of the Northern Region of Ghana. He supervises the implementation of all public health policies in the region, including immunization activities — something he has had an interest in since this early experience working at a district hospital. He added, “That was how I got interested in how to protect these children who, for no fault of [their own], by geography, didn’t have access to routine healthcare services and immunization services.”
Hilarius was inspired to join the 2022 COVID-19 Recovery for Routine Immunization Programs Fellowship due to the opportunity to address the decreasing routine immunization coverage of children in the Tamale Metropolis. The Fellowship, offered by the Sabin Vaccine Institute’s Boost Community and the World Health Organization (WHO), provided an opportunity to strengthen the capacity of immunization professionals, like Hilarius, to recover and bolster immunization programs in their countries.
“As a young medical officer, I started seeing a number of children with vaccine preventable diseases like measles appearing in the hospital. I found out a number of these children were coming from the areas that didn’t have any healthcare facilities and barely [had] access to routine immunization services.” ~ Dr. Hilarius Asiwome Kosi Abiwu
The Unique Struggles of Marginalized Communities in the Wake of COVID-19
The Tamale Metropolis area faces many challenges as one of the poorest regions in Ghana, with a population that works mainly in agriculture and is spread out, making accessing health services difficult. Hilarius noted that reaching some segments of the population for healthcare services was difficult even before COVID-19, but the pandemic exacerbated this problem. During the pandemic, this region experienced several outbreaks of vaccine-preventable diseases, including polio and yellow fever; however, the brunt of time, attention, and funding was focused on COVID-19 vaccination activities, which ultimately came at the detriment of routine immunization services. After witnessing the disruptions and suspensions in routine immunization services in the Tamale Metropolis during COVID-19, Hilarius feared the return of vaccine-preventable deaths in the area, even as COVID-19 receded. Hilarious said of the fellowship, “This was very relevant. It was timely and I think it couldn’t have come at a better time.”
Utilizing Accurate Data to Identify Missed Children
Hilarius recognized that the issues with routine immunization had to be addressed, but the extent of the problem was unknown due to a lack of quality data. Therefore, Hilarius focused his Fellowship project on identifying the breadth of the problem by improving data collection and analysis processes. Hilarius and his team conducted surveys and in-depth interviews in the region, followed by quantitative and qualitative data analysis. He aimed to determine the ability of service provision arrangements to achieve routine immunization goals as well as to determine the coverage rates of all basic childhood vaccinations, with the goal of instituting appropriate recovery efforts to improve routine immunization services. Very soon after this effort began, Hilarius and his team noticed that the quality of administrative data began improving. From there, Hilarius tasked a data validation team with confirming the accuracy of all routine data every month before entering this data into the district health information management system, which also helped clear up data discrepancies.
Moving from Training to Action
Hilarius found the Fellowship integral to the success of his project. He said, “The training was first class.” Beyond that, he added, “The most important part for me was the projects. Usually, most of the trainings and webinars we had during this period of the COVID outbreak, essentially were just didactic. In this particular instance, we had the opportunity of working on something that is very relevant to us and [were] assigned experienced mentors. It gave us the opportunity to immediately apply the lessons and the ideas that we have learned during the first phase of the fellowship to solve real time challenges.”
Challenges arose when approaching the research and methodology of the project. Hilarius said, “We noticed that we haven’t had any serious research experience. So putting the protocol together, getting ethical approval and all of that was quite challenging for us.” Hilarious credited the live sessions of the Fellowship, along with support from his mentor, with improving his research skills in order to successfully implement his project.
With the support of the Fellowship, Hilarius and his team were able to move from research to action. The team shared the data they collected with the health management teams of sub-districts and with community members. Staff members were then assigned to outreach services in these areas and conducted supplementary vaccination activities in the communities with low coverage rates. A representative of Ghana’s Annual Regional Performance Review was impressed by Hilarius’ project and recommended the team submit an abstract to the national level for consideration. As a result, Hilarius was able to share his findings to the Ghana Health Service, which is under the Ministry of Health.
Furthermore, every year the Regional Health Directorate publishes an Annual Performance Report on the best and least performing districts with respect to key EPI Service and Disease Surveillance indicators. The 2021 Report showed that the Tamale Metropolis placed sixteenth out of the sixteen districts in the region, while in the 2022 report, Tamale moved to the ninth position. Additionally, Hilarius wrote a manuscript based on his project finding which he hopes to publish, along with two other publications in development.
However, Hilarius’ work is not finished: he hopes to reestablish high vaccine coverage rates across the entire northern region of Ghana, especially in light of the recurrence of outbreaks in this area.
2022 Fellow & Contributor
Hilarius serves as Deputy Director of Public Health for the Northern Region under the Ghana Health Service. He has led district health teams in Ghana to improve public health indicators, notably achieving zero preventable institutional maternal mortality ratio in Krachi West District. His leadership has resulted in his team being recognized as the best performing district health directorate for five consecutive years. Dr. Abiwu is also a recipient of the prestigious Mandela Washington Fellowship.